What can I do if I have waited more than 18 weeks for NHS treatment?
Short answer
Invoke regulation 45. Where the 18-week maximum is unlikely to be met, your Integrated Care Board must offer you at least one alternative provider — including a private hospital at NHS expense. Escalate through PALS, then a formal complaint, then the Ombudsman, and ask your GP for a clinical priority review.
The 18-week maximum is a right under the NHS Constitution, given teeth by regulation 45 of the Standing Rules Regulations 2012: where a relevant body — your Integrated Care Board — considers on clinical advice that treatment is unlikely to start within the maximum waiting time, it must offer you at least one alternative. That duty bites before the deadline passes, so act as soon as the wait looks like overshooting.
Before the 18 weeks are up
- Find your clock-start date. It is the day the secondary-care provider received your GP referral, not the day you saw your GP. Ask the booking team or check the NHS App, then add 18 weeks.
- Contact your ICB's Patient Advice and Liaison Service (PALS), cite regulation 45 explicitly, and ask it to identify a provider with a shorter wait — including an Independent Sector Treatment Centre or a private provider commissioned at NHS rates. Asking specifically for an ISTC alternative is often the fastest route.
- Use Patient Choice. You can choose any provider commissioned by an ICB or NHS England that meets NHS quality standards, so ask your GP to re-refer you to one with a shorter list.
- Ask for a clinical priority review if your condition has deteriorated, with written evidence from your GP about new symptoms, extra medication, time off work or lost function. The consultant team can re-stratify you to a higher urgency.
- If PALS goes quiet, write to the ICB's Chief Executive, reference regulation 45 again, and keep every reply.
An alternative has to be reasonable. Excessive distance, poor public transport, ill health that makes travelling hard and carer commitments are all relevant — ask for a closer option or NHS-funded patient transport rather than accepting something unworkable.
After the deadline has passed
Complain formally to the provider, and to the ICB as commissioner. Once you have a final response you have 12 months to take the case to the Parliamentary and Health Service Ombudsman. For a clear regulatory breach causing continuing harm, judicial review is possible, but the limit is short — three months from the decision. If the delay has caused or worsened injury, that is a clinical negligence claim instead, with three years from the date you knew about the harm.
One caution: the clock legitimately pauses for documented patient choice, for clinical reasons such as optimising your health before surgery, and for missed appointments — but it does not restart from zero, and the ICB and provider must keep an audit trail of every pause and its justification.
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